Provider Demographics
NPI:1023123205
Name:HENTZE, PATRICIA E (RPA-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:E
Last Name:HENTZE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2000
Mailing Address - Country:US
Mailing Address - Phone:518-828-8363
Mailing Address - Fax:518-697-3388
Practice Address - Street 1:1301 RIVER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-9694
Practice Address - Country:US
Practice Address - Phone:518-758-8300
Practice Address - Fax:518-758-9679
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02246422Medicaid
NY000490562004OtherBSNENY
NY98329OtherMVP HEALTHCARE
NY000490562004OtherBSNENY
NY02246422Medicaid